Provider Demographics
NPI:1649010463
Name:PEOPLES, SHAJUAN BROWN (MA)
Entity type:Individual
Prefix:MS
First Name:SHAJUAN
Middle Name:BROWN
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 UMATILLA BLVD
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8418
Mailing Address - Country:US
Mailing Address - Phone:352-771-2700
Mailing Address - Fax:
Practice Address - Street 1:633 UMATILLA BLVD
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8418
Practice Address - Country:US
Practice Address - Phone:352-771-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder